American family physician
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Supracondylar fractures most commonly result in posterior and medial displacement of the distal fragment. The periosteum on the medial and posterior aspects of the humeral shaft is often intact. Closed reduction with immobilization by casting is preferred. ⋯ Internal fixation with percutaneous pins may be required, but only after satisfactory reduction. Olecranon skeletal traction is useful if ischemia develops. Neuropathies, ischemia and technical failures with angular deformities are not rare.
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Hypoxia must be prevented in the newborn. It causes atelectasis, acidosis and pulmonary vasoconstriction, which leads to further hypoxia and, ultimately, brain damage. ⋯ Administered oxygen must be humidified and heated, and the oxygen concentration must be monitored with each delivery system. It is not enough to know the oxygen flow rate; an oxygen analyzer is essential.
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Diabetic emergencies include diabetic ketoacidosis, insulin-induced hypoglycemia, hyperosmolar coma and lactic acidosis. By determining the blood pressure, observing for evidence of dehydration or sweating and making a rapid qualitative assessment of blood glucose and ketonemia, the physician can usually identify the condition promptly. When adequate facilities are available, continuous intravenous insulin infusion is preferred for treatment of diabetic ketoacidosis. The nonketotic hyperosmolar state should be corrected gradually, not rapidly, in order to avoid cerebral edema.